Michael Reed, MD, MSCP, on proposing sexual health as a pillar of women's health

A newly proposed clinical framework positions women's sexual health as a “Fourth Pillar” of women's health, addressing what its author describes as persistent structural gaps in how sexual function, genital comfort, and intimate well-being are evaluated in routine practice. The framework, published in the International Journal of Sexual Health, was authored by Michael A. Reed, MD, MSCP, board-certified ob-gyn in Davis, California, and a NAMS-certified menopause practitioner.

“The fourth pillar is essentially just a framework. It is not a new specialty. It is not a new checklist. It is a framework to guide how we think and evaluate patients as it pertains to women's sexual health,” he said.

Reed situated the proposal against the existing structure of women's health care, which he characterized as resting on 3 well-supported pillars.

“One is reproduction,” he said, “meaning taking care of mom and baby. We are really good at that. Two is disease-specific treatments. We are helping women with specific diseases, whether it is uterine fibroids, cancer, or any number of disease processes. The third is longevity or preventative medicine.

“Each one of those 3 pillars has clinical pathways, it has training infrastructure and research infrastructure. But what has not had a chance to sit at the table is women's sexual health,” Reed said.

According to the International Journal of Sexual Health publication, this fragmentation persists despite available evidence-based approaches and contributes to delayed care, inconsistent clinical ownership, and patient self-silencing. The framework emerged from a narrative review, with a PubMed search most recently conducted in February 2026 and reporting guided by the SANRA framework.

Reed traced the framework's origin to his own experience seeking care, which reshaped how he approached his patients.

“It was then that I realized that after 16 years, I have never asked my patients how they feel. What are they experiencing? Is intimacy a meaningful part of their life? And so that is what changed the way I thought, and that is what led me to get education,” he said.

The abstract frames the Fourth Pillar as an integrative, multi-domain approach that clarifies how existing evidence may be applied more coherently, rather than mandating intervention, with implications for clinical practice, training, and research.

Reference:

Reed M. Beyond Reproduction and Disease: Proposing a Fourth Pillar of Women’s Health as a Clinical Framework for Sexual Function, Intimacy, and Identity. International Journal of Sexual Health. Published online July 20, 2026. Accessed July 28, 2026. doi:10.1080/19317611.2026.2704787